This study was aimed at determining the prevalence of diabetes among homeless Ghanaians. Diabetes mellitus is the commonest chronic disease in most countries and its prevalence continue to increase due to increasing urbanization mainly as a result of economic factors. The rural urban migration may also lead to reduced physical activity and increased obesity which are both risk factors of diabetes mellitus. The burden of diabetes in all countries, particularly in low and middle income countries where resources are limited, continue to increase and this could be same for homeless people in most of the slums in the big cities in Africa and other parts of the world. People living with diabetes mellitus are projected to increase globally in both developed and developing countries[11].
There is very little information on the prevalence of diabetes in homeless people in Ghana hence this study was conducted and also in the light of the fact that the phenomenon of homelessness has assumed socio-medical issue with high morbidity and mortality among this vulnerable group of the population even in the developed world[12]. Most of the homeless people migrated from the northern parts of the country with few coming from the rest of the country and other neighboring countries. Aside living in dilapidated structures, these homeless people do not have access to basic services with about 92 % of those in Agbogbloshie and 60% of those in Nima having no access to portable drinking water, [12] consequently homelessness is an independent predictor of death from specific illnesses[13].
Our study showed that 5.4% and 10% of homeless migrants living in slums around Nima and Agbogbloshie in Accra, Ghana, had diabetes and prediabetes mellitus respectively. This is slightly lower than what had been reported almost two decades ago [14] but in consonant with IDF’s global estimates of diabetes prevalence and projections from 2013 to 2035.[1] A survey in Ireland showed prevalence of diabetes among homeless Irish population to be 8% whilst prediabetes was found to be 10%. [5] Of the 5.4% (7 out of 130) participants in this present study with DM, 42.9% were men (n = 3) and 57.1% (n = 4) were women. This is contrary to what had been reported in Ireland where among the 8% of homeless people with diabetes, 85% of them were men and 15% were women[5]. In another study in Japan, the prevalence of diabetes in homeless people was reported to be 6.6%[4]. Differences in the population dynamics, diet and eating habits could be responsible for the differences in the prevalence of diabetes in homeless populations in different parts of the world. Our study also revealed higher prevalence of diabetes among obese homeless population which is in consonant with the study of prevalence of diabetes, prediabetes and metabolic syndrome among Irish homeless population.[5] A previous study in Nagoya, Japan reported 9.4% prevalence of diabetes among homeless people who consume alcohol as compared to 2.4% of their counterparts who did not consume alcohol [4] in line with this present study which showed association between alcohol consumption and diabetes mellitus among homeless people in Nima and Agbogbloshie, Accra.
The prevalence of diabetes in this study is in line with existing data on diabetes prevalence in Ghana, therefore more attention needs to be directed to this group of people since they may be reluctant to visit hospital because of financial problems and may not be diagnosed early. It has been estimated that in Ghana, about 70% of cases of diabetes are underdiagnosed as a result of lack of awareness a situation that could lead to late presentation of the disease with its accompanying complications [14] and in Tanzania 80% to 90% people with diabetes have not been diagnosed.[15] Patients with diabetes mellitus will require regular visits to health care facilities for medical care which could be very expensive for individuals, families, society, health professionals and could have effects on national productivity[16]. The national health insurance scheme (NHIS) in Ghana has been helpful in reducing the cost of health care in the country, however, the country is still struggling to achieve NHIS’s goal of universal health care because many members do not renew their insurance policies annually,[17] especially the homeless men and women including the "Kayayei” who cannot afford to renew their policies because of financial constraints and lack of awareness of existence of exemption policies if any.
Although the prevalence of diabetes in our cohort was slightly lower than that of the background population, this study shows that diabetes is still a major chronic health problem among this vulnerable group. The daily struggles of this people for livelihood, lack of NHIS cards, as well as other social factors makes health needs of these people a distant priority, hence they are most likely to present themselves for treatment during the later stages of diabetes with complications such as heart diseases, retinopathy, nephropathy and neuropathy which are 3.5 times higher in those with lower socioeconomic status[18].